DESCRIPTION (Applicant's Description) Over the past 20 years, the management of primary breast cancer has evolved from a purely surgical treatment of the primary cancer to include acceptance of lumpectomy followed by radiation therapy and adjuvant therapy in many patients. The addition of postoperative chemotherapy and/or hormone therapy has improved overall survival in breast cancer patients. Depending on the type of therapy selected, patients may experience psychological trauma due to hair loss, weight gain, lethargy, and premature menopause. The psychological literature has focused principally on the impact of the primary surgery on the patient's quality of life and emotional adjustment. The additional psychological traumas related to adjuvant therapy have been insufficiently studied, to date. We propose to study the interrelationships amongst clinical, psychological, and social determinants of quality of life in women receiving adjuvant treatment for localized breast cancer. Changes will be studied at initiation of adjuvant therapy, and 2, 6, and 12 months after initiation of adjuvant therapy. For purposes of this proposal, quality of life includes: general quality of life, cancer specific quality of life, psychological adjustment, marital satisfaction, and sexual functioning. The needs for psychosocial support in these women change over the first year following localized surgical treatment of the primary cancer. We hope to systematically explore those changes to meet the following specific aims: 1. Develop an on-going needs assessment of support in coping with breast cancer and its treatment at key points during the first 12 months after surgery of the primary breast cancer. 2. Characterize the patient's changes in quality of life and related factors, including general quality of life, cancer-specific quality of life, psychological adjustment, marital satisfaction and sexual function during the 12 months following initiation of adjuvant therapy. 3. Characterize changes in clinical, psychological, and social influences on quality of life and related factors during the 12 months following initiation of adjuvant therapy. 4. Characterize changes in relationships, both new and old, as the patients' needs for clinical, psychological, and social support are altered during the 12 months after surgery for primary breast cancer. 5. Characterize how changes in clinical, psychological, and social support impact on the patient's outcome as measured by quality of life.